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Table of Contents

• Going Around This Week: Vomit/Diarrhea Bug

• Money-Saving Tip: Know About Prior Authorization

• Recalls & Alerts: High Chairs

Going Around This Week: Vomit/Diarrhea Bug

We’re having a local outbreak of gastroenteritis, the vomit/diarrhea bug.

(I’m happy to report that last week’s positive flu case seems to have been a true one-off case. I haven’t seen any more cases since.)

To be clear, this vomit bug is NOT influenza. While we haven’t specifically tested to see what virus it is (it isn’t practical or cost effective to do so), I suspect Norovirus. It’s the most common cause of gastroenteritis in the U.S. and is generally a fall and winter bug.

Here’s the quick scoop on gastroenteritis:

1. The vomiting aspect is usually at the beginning of the illness (the first 24-72 hours).

2. Diarrhea typically follows and can last up to 10 days.

3. It is highly contagious, so wash hands frequently and disinfect surfaces to prevent the bug spreading through the whole family.

4. Other associated symptoms include fever, nausea, headache, body aches, and loss of appetite.

5. Treatment is all supportive (meaning there isn’t a medicine that will cure it). The key is keeping hydrated and managing symptoms for comfort (e.g., giving a fever reducing medicine like Tylenol).

6. Stay home from school and/or work until you are fever free and haven’t vomited for at least 24 hours. If there is any remaining diarrhea, it needs to have slowed to the point of going many hours between episodes.

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Money-Saving Tip: Know About Prior Authorization

One of my children takes a daily medication for a chronic condition. As this child has grown, we have had to increase the dose of the medication. The medication dose was increased this week, and the cost went from $20/month to $178/month.

Ouch!

To be clear, the medication didn’t change, just the dose. Rather than pay for it, I asked the pharmacy to send a Prior Authorization form to the doctor’s office.

So, what is a prior authorization form?

I almost hesitate to tell people about the prior authorization as they suck up hours and hours of my time (or my staff’s time) a week, but they can truly be money saving. When your insurance denies coverage of a medication, sometimes a form can be filled out by the doctor to essentially make a case medically as to why the medication should be covered. The form is sent by the pharmacy to the prescribing doctor who then fills it out and submits the form to the insurance. The whole process typically takes a few days. While we often get informed that the PA was denied, we sometimes have success getting medications covered. The most common successful arguments include:

1. Insurance dictated medication changes that have made the patient’s chronic health condition worse (e.g., the patient’s asthma was well controlled on one medication and then got worse when they had to change the medication because the previous one was no longer covered).

2. Same medication, just a different dose. Sometimes insurance companies will cover one dose of a medication, but not another dose (as in our case).

3. If the patient has tried a handful (typically 2-3) of covered medications to treat a condition and hasn’t had improvement on those medications. Then we can usually argue for a non-covered medication.

4. If the insurance covered alternatives aren’t age appropriate. This can include things like the insurance only covering pills and the patient is a baby who can’t swallow pills or listed covered medications are indicated for people 18+ years and the patient is a child.

I’m happy to report that our PA was approved, and I picked up the medication at the pharmacy today.

COST SAVINGS: $158/mo. That’s $1,896/year. Some serious savings!

Recalls & Alerts: High Chairs

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Legal Disclaimer: The information provided in this article is for educational and informational purposes only. It is not intended as a substitute for professional advice or medical treatment. Always seek the advice of your physician or qualified healthcare provider with any questions you may have regarding a medical condition or the health and welfare of your child. We do not endorse any specific products or brands mentioned in this article. Readers are encouraged to perform their own research and consult with appropriate professionals before making any decisions based on the information provided herein.